We Need to Recognize Complex PTSD in Order to Treat It

My life is naturally governed by fear. If I do not stage a coup against it at any and every given moment, fear will walk my feet and talk my tongue and think my brain until it successfully shuts me out from reality. I am its prisoner unless I fight, and the war, it seems, is never-ending. This has not always been the way of things. There was a good deal of time when I was a zygote, a blastocyst, an embryo, a young fetus even, that I was not being taught to fear the world and the people in it. But it is almost certain that my parents began to cut systemic wounds even as I was in the womb.

I am describing complex post-traumatic stress disorder (C-PTSD), a psychological condition that results from an extended period of trauma, often beginning in childhood, during which the victim was unable to escape, physically or emotionally. It can stem from circumstances as appalling as time spent in labor or POW camps, brothels, or in childhood sex trafficking. It can come from the more everyday horrors of long-term physical or sexual violence. It can come from chronic emotional abuse, objectification, bullying, or even the feeling of neglect.

In my case, the cause was plural. My parents were only married for two years of my life, but their time together was punctuated with brutality. My first inkling of the brutality in my parents’ short-lived marriage came when my mother told me to “never stay with a man that beats you.” I was twelve then. I wrote her words into a poem and turned it in as an assignment for my writing class. I’m certain now that my teacher, a man who I wish to this day had been my father, contacted my mother about what I had written. I don’t know what she would have said to him. What would you choose to share with your daughter’s seventh grade mentor?

Would she have told him that my father sat on her stomach and beat her so badly that she went to the emergency room with a bruised and broken face? Would she have told him that my father had raped her multiple times? Would she have said that my father had kidnapped me once after their divorce, taking me away only after clenching his angry fingers around her throat and throwing her to the floor? No one has established the etiquette yet.

Some of this violence overlapped with my mother’s pregnancy. She never told me how much, but it was enough to say aloud. I’ve done my research. Ever since my therapist gave me the diagnosis of C-PTSD, I started reading. One of the first books was What’s Going On In There? How the Brain and Mind Develop in the First Five Years of Life by Lise Eliot, Ph.D. She’s a professor of neuroscience at the Chicago Medical School and a mother. She wanted to know how her decisions as a parent—how the decisions of any parent—would affect how children’s brains developed.

According to Eliot, “mothers who are unduly stressed during pregnancy, or who are very anxious personality types, may ‘overdose’ their fetuses with chronically high levels of corticosteroids and catecholamines,” hormones that can cause high blood pressure and heart rate, depression, insomnia, mood swings, and personality changes. They both trigger the “fight-or-flight” response in adults. Studies in rats show that fetuses of stressed mothers experience slowed growth in their hippocampus, the part of the brain that controls learning and memory among other things, and “abnormalities in the pups’ own stress response system.”

She also found that “fetuses as young as twenty-three weeks of development respond to sound stimuli,” and that “fetuses can not only hear before birth, [but] they also remember what they’re listening to, and their ability to learn about familiar sounds in their environment may, like learning about familiar smells and tastes, help provide a comforting introduction to the world that awaits them at birth.” But what if the familiar sounds don’t provide comfort, but dread? I would have heard the fights and felt my mother’s fear. The eruptions between my parents during her pregnancy affected how my brain developed—and not positively.

Sleep didn’t feel safe without Mama when I was young, but being in my father’s house wasn’t much different. He lived with a girlfriend and she didn’t like me much. There was a guest bedroom that could have been mine, but it shared a wall with the master. Because they’d have to curtail their sex life every other weekend to accommodate my visits, I slept instead in the basement, two floors away. It was finished, but only just. I don’t remember there being any trappings of a normal child’s room: just a bed. I was scared of the dark and of the spiders that potentially lived in the dark, but I never said a word to my father. I was probably too afraid.

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Everyone is familiar with “regular” PTSD, the type that affects soldiers returning from war or rape survivors. What most people don’t know is that chronic trauma of every sort can cause a person to develop the symptoms of PTSD. Like those “shell-shocked” veterans, I have flashbacks (instances of reliving the traumatic event), persistent nightmares, and difficulty sleeping and concentrating (this, on top of ADHD). I avoid anything that might remind me of the suffering I have experienced. Bars, music, books, clothing—if it triggers a cruel memory, I give it a wide berth. I cringe at loud noises and harsh tones before I know what I’ve done. If I feel the brunt of someone’s real or imagined anger, I make myself small and unnoticeable.

With C-PTSD, there come additional hardships. I felt for most of my life that I had to depend on my friends and boyfriends in order to survive. Often, I did. My mother kicked me out of her house three times in high school. We’d argue, she’d lose her temper, and that was how she’d “win.” The friends that I’ve kept in the ten years since then are the ones that asked their parents if I could spend the night when drama rehearsals ran late, the ones who bought me Chinese food after a panic attack, the ones who saw me cry when I couldn’t bear my burdens alone.

However, this dependence mercilessly plays into another symptom: the near-constant terror of being abandoned. As Bessel van der Kolk, professor of psychiatry at the Boston University School of Medicine, founder and medical director of the Trauma Center in Brookline, MA and author of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, writes, “Trauma, whether is it the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships. After you have experienced something so unspeakable, how do you learn to trust yourself or anyone else again?”

I have adapted as a result. Although I’ve paid my own bills since I was fifteen and lived independently since nineteen, I still dread the idea of not having someone to rely on and so I’ve relationship-hopped since I was seventeen, always keeping a safety net between me and aloneness. The aloneness that I felt so strongly when I was a child.

I decided that I would build upon my “friend-fam,” as I called them, with a more traditional family: one borne out of romantic love. First, there was a sweet boy I dated long-distance for two and a half years. We had planned a wedding date—two years after our college graduation—but when we finally finagled ourselves into the same city, the urgency of sex died in him and so did our relationship. Next came a guy I met at a party, someone who I thought was my best friend, but who was nothing more than an amalgamation of his own traumas. He used them as excuses for lies, emotional abuse, and outright coldness until I moved out.

I didn’t leave, though. Not fully. We kept having sex and spending time together, sometimes in exactly the sweet ways I craved. But the majority of our rocky aftermath was more than a continuation of how he’d treated me when we were “together”: Since I wasn’t his girlfriend anymore, he didn’t have to tell anyone about me, bring me to his house, or go anywhere with me that we might be seen. Still, I clung. I was addicted to the pain. As van der Kolk says, “If you conclude that you must be a terrible person (because why else would your parents have treated you that way?), you start expecting other people to treat you horribly. You probably deserve it, and anyway, there is nothing you can do about it. When disorganized people carry self-perceptions like these, they are set up to be traumatized by subsequent experiences.”

It’s true. It was only after my third major relationship (an affair with my ten-years-older internship supervisor that somehow turned into an engagement) that I entered therapy and was told I had symptoms of PTSD. I couldn’t stand to listen to any of the music I’d grown fond of over the past three years with my ex. I threw out the majority of my clothes. I was outright frightened of big tan cars—doppelgangers to his.

The same happened when I left my husband: I took the essentials, trashed anything that could bring about his memory, and tried to bury the rest as deep down as I could. But the truth was that I had loved him deeply, enough to ignore his functional alcoholism and our diverging paths, and my grief erupted in ways I had never thought possible. Until I’d read more about the impacts of trauma, I didn’t know that sudden vomiting could be caused by a triggering memory—the vagus nerve, which runs from your brain stem down your spine to your stomach, is responsible, along with other symptoms like dry mouth and chest pains—or that my constant shame was not a sign to work things out, but a symptom of trauma.

But there are so many things that people do not know about C-PTSD. We think of trauma and camouflage uniforms spring to mind, but what we do not know is that, according to van der Kolk, “for every soldier who serves in a war zone abroad, there are ten children who are endangered in their own homes.” We don’t know that half of all people who seek psychiatric care have been somehow traumatized as a child. We don’t know that elementary school bullying can have just as much of an impact as being an adult rape survivor, and we don’t know that, as Judith Herman, Harvard professor of clinical psychology and first recognizer of C-PTSD wrote in in her 1992 article Trauma and Recovery, “the community must take action to assign responsibility for the harm and to repair the injury. Recognition and restitution are necessary to rebuild the survivor’s sense of order and justice.”

Twenty-five years have passed since the publication of that article, and yet our communities still lack fundamental solutions to the scars of complex trauma. The latest issue of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the go-to reference manual for therapists and psychiatrists in America, still does not recognize this diagnosis. The World Health Organization’s International Classification of Diseases is only now permitting C-PTSD to grace its pages. Hell, if you choose to Google C-PTSD, the first line on the results page will be “Did you mean: PTSD?”

If you know where to look, there are written resources bursting with knowledge about treatments for C-PTSD. Art therapy, Eye Movement Desensitization and Reprocessing (EMDR), yoga, neurofeedback, community theater, psychomotor therapy—these are all techniques that have been well-proven to help if not cure people with C-PTSD, and yet what do you know of any of them? If a dear friend came to you with symptoms of C-PTSD, would you be able to suggest the diagnosis to them, as one would with depression or anxiety? Would you be able to recognize their trauma and help them find restitution?

I came across a beautiful word the other day—Nepenthe (n.): something that can make you forget grief or suffering—and was immediately struck by how much we need just the opposite when it comes to C-PTSD. We need a reminder, a dispatch, a signal to act so that those of us who think they just have baggage or “daddy issues” or a not-so-great childhood can come to the realization that this isn’t normal, they’re not alone, and there is a community of caretakers waiting to receive them. But first, we need that community to know we exist, to be comfortable extending a supportive hand, and to know how to lead the way.

"Liz Lazzara is an androgyne writer, editor, and activist specializing in mental health, addiction, and trauma. They have written copy for rehab centers, essays, narrative nonfiction, and journalism for multiple online and print publications. They are currently working on a manuscript about complex post-traumatic stress disorder and addiction, and they are affiliated with Active Minds, the Mental Health America Advocacy Network, the National Alliance on Mental Illness (NAMI), the National Association of Memoir Writers, the Nonfiction Authors Association, No Stigmas, & the One Love Foundation."